Managing the airway in cervical spine injury

Wood, P. R.

doi:10.1111/j.1365-2044.1992.tb03259.x

Cited by 36 publications

(2 citation statements)

References 59 publications

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“…The method taught for management of the airway in the trauma patient has been criticized recently [3,4]. Students are taught that, in the breathing but unconscious patient with either proven or suspected cervical spine injury, intubation should be per-formed using a blind nasotracheal technique.…”

mentioning

confidence: 99%

A survey of nasotracheal intubating skills among Advanced Trauma Life Support course graduates

McHale¹,

Brydon²,

Wood³

et al. 1994

British Journal of Anaesthesia

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The American College of Surgeons' Advanced Trauma Life Support procedure teaches that blind nasotracheal intubation should be performed in the presence of a suspected or proven cervical spine injury in an unconscious but breathing patient who requires an artificial airway. We studied a group of non-anaesthetically trained graduates of the Advanced Trauma Life Support course and examined their skill in performing blind nasal intubations. Only six in 90 attempts were successful. We conclude that, in British hospitals, blind nasotracheal intubation should not be recommended as the first line management in securing the airway of patients with suspected or proven cervical spine injury. Alternative techniques such as bag-and-mask ventilation with cricoid pressure or a laryngeal mask airway with cricoid pressure should be adopted until oral intubation with in-line traction is performed.

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mentioning

confidence: 99%

A survey of nasotracheal intubating skills among Advanced Trauma Life Support course graduates

McHale¹,

Brydon²,

Wood³

et al. 1994

British Journal of Anaesthesia

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“…It is less successful than direct laryngoscopy and oral intubation and has a higher risk of aspiration (Dronen et al, 1987). In addition, bleeding, coughing, laryngospasm and unrecognized oesophageal intubation can all occur and for these reasons this technique has been criticized by anaesthetists in the UK (Wood and Lawler, 1992). The trauma victim with a compromised airway is not the case in which to be attempting this technique for the first time!…”

Section: Management Strategymentioning

confidence: 99%

Airway management: the difficult airway

Bryden

Gwinnutt

2000

Trauma

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Maintenance of a patent airway to allow ventilation with high concentration oxygen is an essential procedure during the resuscitation of all trauma patients. A range of equipment is available to help achieve and maintain a clear airway, with endotracheal intubation remaining the gold standard. However, in trauma patients attempts at intubation are often impeded by the presence of associated injuries and the application of devices to immobilize the cervical spine. In the situation of ‘can’t ventilate, can’t intubate’ a surgical airway can be life-saving while expert help is sought. Recently, new devices, in particular the laryngeal mask airway and Combitube®, have gained recognition as having a role in difficult airway management when other methods have failed, thereby reducing the need for surgical intervention. This paper presents an overview of the currently accepted methodology of managing the difficult airway in the trauma patient.

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